In Reply.—Dr Rosen's interesting historical anecdotes about adenotonsillectomy reflect both concern and uncertainty about the role of the tonsils in the maturation of the immune system. We do not disagree that the tonsils have an important role in immunity, but the evidence to date fails to disclose exactly what that role is. Retrospective studies such as those by D'Amelio et al1 do not prove that tonsillectomy lowers serum IgA—only that people who had tonsillectomy have slightly lower serum IgA (but have no demonstrated clinical disadvantage as a consequence). Not excluded is the distinct possibility that they had low secretory IgA preoperatively, hence their problem with recurrent throat infections that led to the tonsillectomy. In a prospective study of nearly 200 children with severe throat infection, there were no differences in secretory IgA levels or other measures of immune function preoperatively vs postoperatively or between those who underwent
GATES GA. More on Adenotonsillectomy-Reply. Arch Otolaryngol Head Neck Surg. 1986;112(12):1304. doi:10.1001/archotol.1986.03780120068023
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